【摘要】 目的通过观察动态有效瓣口面积指数(effective orifice area index,EOAI)的变化,评价两种扩大瓣环主动脉瓣置换术的中期效果。方法总结30例扩大瓣环的主动脉瓣置换术患者的临床资料和术前、术后早期和中期动态EOAI变化及其他超声心动图指标,并和同期常规主动脉瓣置换患者29例的资料进行比较。结果采用Konno法12例,Manougnian 18例,扩大瓣环组早期病死率3.33%,早期心律失常发生率76.3%,低心排血量综合征发生率34.1%。随访21～109个月,随访率100%。Konno亚组和Manougnian亚组3年后左心室质量指数、左心室厚度、平均跨瓣压差比较,差异无统计学意义(P>0.05)。普通瓣膜组与扩大瓣环组术后1年、3年生存率比较,差异无统计学意义(96.5%vs.96.5%,P=0.23;86.2%vs.89.65%,P=0.14)。Manouguian亚组与Konno亚组3年生存率比较,也差异无统计学意义(91.6%vs.88.23%,P>0.05)。扩大瓣环组和普通瓣膜组相比,手术时间,传导束损伤发生率差异有统计学意义(P<0.05)。术后3年时,Manougnian亚组和Konno亚组EOAI值高于普通换瓣组,其中Konno亚组高于Manougnian亚组,差异有统计学意义(P<0.05)。3年随访中和Konno亚组Konno亚组和Manougnian亚组相比,延迟性瓣膜不匹配现象(dalated prosthesis-patient mismatch,DPPM)发生率差异有统计学意义(10.0%vs.26.6%,P<0.05)。结论两种扩大瓣环方式行主动脉瓣置换术在青少年患者中均获得良好的中期效果。从动态EOAI指标观察,Konno法较改良Manougnian法更能达到扩大瓣环直径的效果,DPPM发生率明显降低。Konno法发生DPPM的比例明显低于Manougnian法,Konno法有较大优势,可以作为青少年患者主动脉瓣置换术的首选方法。更多还原

【Abstract】 Objectives To asses the intermediate-term clinical outcomes by changes in effective orifice area index(EOAI)in patients with small aortic annulus who received aortic valve replacement(AVR) enlargement of aortic annulus using two kinds of operations.Methods Thirty patients received AVR with enlargement of aortic annulus using Konno operation and Manougnian;s operation were included in this study.Electrocardiogram(ECG),echocardiography(UCG),clinical symptom and changes of EOAI in Konno operation group and Manougnian;s operation group were reviewed and compared with those in control patients received ordinary AVR during the same period.Results Twelve patients were in Konno operation group and 18 in Manougnian;s operation group.At the prophase stage,case fatality rate of enlargement operation was 3.33%,incidence rate of arrhythmia was 76.3% and incidence rate of low cardiac output syndrome was 34.1%.They were followed up for 21-109 months with follow up rate of 100%.There was no significant difference in regression of left ventricular wall thickness,mass index and mean transvalvular gradients between Konno operation group and Manougnian;s operation group after 3 years(P>0.05).There were no differences in 1-year survival rate and 3-year survival rate between enlargement operation group and ordinary operationro group(96.5% vs.96.5%,P=0.23;86.2% vs..89.65%,P=0.14).The 3-year survival rates between Konno operation group and Manougnian;s operation group had no significant difference(91.6% vs.88.23%,P>0.05).Difference in duration of operation and incidence of bundle-branch damage between enlargement operation group and ordinary operation group was significant(P<0.05).Values of EOAI in Konna group and Manougnian;s group were higher than that in ordinary operation group,and it was higher in Konna group than in Manougnian;s group.The differenes were significant(P<0.05).Incidence rate of dalated prosthesis-patient mismatch(DPPM) in Konno operation group was significantly lower than that in Manougnian;s operation group during a 3-year follow-up(10.0% vs.26.6%,P<0.05).Conclusions Both Konno operation and modified Manougnian;s operation can achieve a satisfactory intermediate-term result in patients with small aortic annulus.In view of changes in EOAI,Konno operation can obtain a better outcome of enlargement of aortic annulus than Manougnian operation with a significantly lower incidence rate of DPPM.更多还原